03973 (CP)P.O. BOX 1504 7 >�
Building -4Eisenhower 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner „
Mailing ric4 of Palm Springs - BUILDING: -TYPE CONST., OCC. GRP.
Address-►;�'�, �,
A.P. Number
City Zip Tel. " "•
Legal Description
Contractor Pt 4se to P001, 014
Steve Dodson coast Project Description.;--
fti , . d .
Address 668-703 Peres PA., A-n
City Zip Tel.
Cathedral Ci 92234-32941232
State Lic. City
& Classif. 4SS607 Lic. # 1944 a .�, m. .Sq. Ft., , No. h No. Dw.
Arch., Engr.,
Size Stories Units
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.'
_SIGNATURE DATE
OWNER -BUILDER DECLARATION Estimated Valuation y
I hereby affirm that I am exempt from the Contractor's License Law for the following U/00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a �'
permit to construct, alter" improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Plan Chk. Bal.V49.42
❑ I, as owner of the property, or my employees with wages as their sole compensation, will ry�do the work, and the structure is not intended or offered for sale. (Sec. 7044, Bussness and COr1St. ! p
Professions Code: The Contractor's License Law does not apply to an owner of property who 7 �4 * ! � y
builds or improves thereon and who does such work himself or through his own employees, Mech. ,IkW 47 V
provided that such Improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden Electrical 20,00
of proving that he did not build or improve for the purpose of sale.) +�
O I, as owner of the property, am exclusively contracting with licensed contractors to con- Plumbing 112 rr 40
struct the project. (Sec. 7044, Business and Professions `Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.1. p60
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
❑ I am exempt under Sec. B. 8 P.C. for this reason Grading
Driveway Eric.
Date Owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
O Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL S.:9id I
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS' COMPENSATION INSURANCE rf y 7 pycna�
(This section need not be completed if the permit is for one hundred dollars ($100) valuation I tkRAt if3�l i�t` t91fa' h"'176n. ;�, rq;(i' d
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out, signed and validated, and is subject to 4C g [3
expiration if work thereunder is suspended for 180 days. TT 6 ti
I certify that I have read this application and state that the above Information is correct. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above -
mentioned property for inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, Zip
WHITE —FINANCE, PINK - APPLICANT, GREEN - BUILDING, GOLOEN19D • i►SSESSOR'S OFFICE, HARD COPY - FILE
CONSTRUCTION ESTIMATE
NO.
ELECTRICAL FEES
NO.
PLUMBING FEES
1ST FL" SO FT rp
2ND FL SO FT. git
POR SO FT a
GAR SO. FT. *
CAR P. SO FT. a
WALL SO. FT. rd
SO. FT. Id
ESTIMATED CONSTRUCTION VALUATION
$
UNITS
YARD SPKLR SYSTEM
MOBILEHOME SVC.
BAR SINK
POWER OUTLET
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
$
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTONDISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY'
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. ® c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID g 1 % c
SEWAGE DISPOSAL
SO.FT.GAR r 3:c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DEL
TOTAL FEES
MICRO FEE
MECH.FEE
'L.CK.FEE
I
CONST. FEE
ELECT. FEE
SMI FEE
PLUMB FEE
STRUCTURE PLUMBING ELECTRICAL HEATING 8 AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
LL. AREA
SLAB GRADE
ROUGH PLUMB
BONDING
HEATING (ROUGH)
ORAGE TANK
rROCKStORAGE
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
'
,FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APP.IEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. ytl.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR,
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL